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Tara Moss: Getting rid of the breastfeeding taboo.

On Friday I was honoured to open the 4th biennial Breathing New Life Into Maternity Care conference in Melbourne as part of my role as UNICEF Patron for Breastfeeding for the Baby Friendly Health Initiative (BFHI).

So, why breastfeeding and why do we need a baby friendly initiative in Australia?

The good news is that Australian women have the legal right to breastfeed anytime, anywhere their child needs it. The other good news is that our exclusive breastfeeding rate at the medically recommended six month mark has risen from 14% to 15% in the past year. This is great progress. Unfortunately though, that 15% exclusive breastfeeding rate is still half the world average and with the importance of breastfeeding now very well documented, the World Health Organisation, UNICEF and health practitioners nationwide are hoping to raise breastfeeding rates.

Consider this: The 2010 Infant Feeding Survey conducted by the Australian Institute of Health and Welfare found that more than 9 out of 10 mothers in Australia want to breastfeed.The Survey also found that the majority of women quit breastfeeding before they chose to.Our excellent breastfeeding initiation rate of 96% drops to only 15% at the recommended six months. It drops quickly and it drops quickest in lower socio-economic groups. Why? According to the Survey, the common reasons for not breastfeeding include ‘previously unsuccessful experience’, ‘so my partner can share feeding’ and ‘infant formula as good as breast milk’.

For women in some areas of Australia the importance of breast milk is well understood but a lack of breastfeeding support sees them forced to quit when common problems arise, leaving them frustrated and disappointed. For others, the differences between breast milk and formula, particularly the protective aspects of breast milk – like mum’s valuable antibodies and immune cells – are simply not understood.

We also know that return to work remains a major barrier for many breastfeeding mothers. A fantastic program called Breastfeeding Friendly Workplaces (unrelated to BFHI), encourages businesses to put basic protocols in place to allow breastfeeding breaks or to have a place to store expressed breast milk at work, all of which makes good ethical sense but also good business sense. But until more businesses become baby friendly and breastfeeding friendly, many women will continue to feel that they are faced with tough choices about how to combine breastfeeding and work.

A breastfeeding friendly culture is clearly important for Australia and Australian women want it. And a breastfeeding culture is not just a culture that supports the initiation of breastfeeding, but that also supports continued breastfeeding and everything that involves.

Personally, it wasn’t until I was pregnant that I actually realised I had reservations about breastfeeding. In hindsight, I can see that these reservations were largely informed by comments in the media and in popular entertainment, by friends and by strangers, about pain, pushy midwives, saggy post-feeding breasts, biting and even the more supposedly liberate modern choice to skip breastfeeding altogether. I worried I would be embarrassed in public while nursing. I’d heard a lot of horror stories and as a result I mistrusted my body’s ability to do it at all.

The fact is, many of us only hear about breastfeeding in the context of women’s negative experiences in trying unsuccessfully to do it. Negative stories, particularly extreme ones, are always retold with greater frequency than stories of what is more common, uneventful or positive.

So what I discovered when I became a mother surprised me. I was amazed to learn that breast milk is not just a source of nutrition, but contains illness fighting antibodies and immune cells, and even stem cells, which were discovered only a few years ago. I was also amazed to find that breastfeeding, when it works, is as enjoyable for mums as it is for babies, is remarkably convenient and easy, and that while nursing is natural, it is also learned. The reasons for this are complex, but the first and most basic reason is that we don’t see breastfeeding. We don’t watch breastfeeding happen, and we therefore don’t instinctively understand all that it involves.

Our culture has made breastfeeding all but invisible and taboo. Many are openly squeamish about it. In our culture breasts are commonly viewed as sexual organs, but not as a source of nutrition.

The TIME magazine cover

It’s telling that there was something of a furore caused by the recent cover of TIME magazine. The mother on the cover was feeding her 3 year old. Now that I am a mum, and I have seen breastfeeding regularly, I find the idea of feeding a 3 year old beautiful and unremarkable. It seems normal to me. Many others reacted strongly against the image for a whole variety of reasons, but most of the debate once again centered on the issue of public breastfeeding and the idea of feeding past age one.

Imagine if the mother on the cover, Jamie, were feeding her 5 year old adopted son, whom she breastfed successfully? Or a child older than that, as some women I know have? As her own mother did with her, to age 6? Remember, the World Health Organisation encourages breastfeeding to age 2 AND beyond. What we call ‘extended breastfeeding’ is normal in other parts of the world, but here, after one year, perhaps even before then, the comments about weaning start.

I was told to quit before 7 months because of teeth. I was also told to quit because ‘breast milk has no value after six months’ and ‘you’re only doing it for yourself’.

We’ve all been fed a lot of misinformation about feeding.

And like a lot of people, I didn’t know about the potential for help with ‘re-lactation’ for women who have encountered breastfeeding troubles and stopped, the existence of milk banks (still just being established in Australia and not yet widely available) and the well established but little known fact that many women are able to successfully breastfeed their adopted children, even if they have never been pregnant.

But back to TIME magazine for a moment. Personally, I have yet to see a mainstream portrayal of breastfeeding that has NOT caused intense debate of some kind.

US actor Angelina Jolie’s appearance on the cover of W magazine in 2008, breastfeeding one of her twins in a modest black and white photograph taken by her partner Brad Pitt caused a furore. Her baby was a newborn, the image showed no cleavage, and no, her child was not standing on a chair. Similarly, last year a natural-looking photograph of supermodel Miranda Kerr breastfeeding son Flynn caused mixed reactions of praise and disapproval, while provocative photographs of her in lingerie and swimwear don’t cause so much as a whiff of controversy. Images of nursing are still routinely flagged as offensive on Facebook and banned. Even the cover of a comic called ‘Saga’ featuring a breastfeeding character (dressed modestly, and with no nipple or cleavage showing) was deemed ‘inappropriate for children’ by some.

Inappropriate? For children?

Unfortunately, while we have become accustomed to seeing the fertile female body used to sell us all kinds of products, we are no longer accustomed to seeing it perform this most natural task. Anti-discrimination laws protect a woman’s right to breastfeed anytime, anywhere, but without normalising the sight of breastfeeding in our society we have little hope of making more mothers comfortable enough to engage in the practice, or continue it once life inevitably involves taking a hungry baby out of the house.

This is one of the reasons why initiatives like the Baby Friendly Health Initiative – spearheaded by the World Health Organization (WHO) and UNICEF – are so important.

BFHI, which has been implemented in over 150 countries, has had great success in helping women around the world in their goals to successfully breastfeed. BFHI accredited hospitals encourage skin-to-skin contact between mother and baby for at least an hour immediately after birth (for natural and caesarian births and for breastfeeding and non-breastfeeding mothers). Mothers and babies room in together 24 hours a day. The hospital does not promote formula companies by giving out gifts of free infant formula samples, only encourage formula use if medically indicated or by mothers informed choice, do not suggest dummies or artificial teats (to avoid nipple confusion before breastfeeding is well established), and maintain quality education for all staff to ensure consistent evidence-based advice and feeding assistance for all mothers.

Hospitals with these simple protocols have dramatically higher success rates for breastfeeding, and also result in mothers breastfeeding for markedly longer durations, with better health outcomes for mother and baby, including significantly lower rates of illness, obesity and SIDS ( http://www.smh.com.au/lifestyle/life/no-question-mothers-milk-lowers-sids-risk-20120516-1yrbg.html ). Just one success story from the BFHI initiative: In China, which now has more than 6,000 Baby-Friendly Hospitals, exclusive breastfeeding in rural areas rose from 29 per cent to 68 per cent and in urban areas, from 10 per cent to 48 per cent, in only 2 years of being introduced.

BFHI is keen to soon launch the BFHI Community program for Child and Family Health Centres, which implements the ‘7 Point Plan for a Baby Friendly Community’. This focuses on providing consistent information, resources and support for mothers once they leave the hospital to assist them in maintaining exclusive breastfeeding for the recommended 6 months, and to introduce complementary foods whilst continuing to breastfeed for up to two years and beyond.

BFHI is one valuable way we can give parents consistent care and advice on breastfeeding, so they can achieve their breastfeeding goals and wean when it is right for them, and not when a problem arises or when they are pressured to quit. That is why I am proud to be patron of the initiative.

Personally, I understand the importance of getting consistent advice because I wasn’t lucky enough to get it myself. Shortly after she was born, my daughter was prescribed formula by the paediatrician at the non-BFHI accredited hospital where I gave birth, as he believed my milk was slow to come in and my daughter had mild jaundice.

At only two days of age my daughter was faced with bottles. She then failed to put on weight despite my best efforts to breastfeed and an increasing insistence from the doctor to give her additional formula feeds. She cried a lot, vomited often, did not sleep well and was not putting on weight. At the same time, in addition to conflicting messages in the media and from strangers, I was also getting negative messages at home. An older visiting relative of mine, a mother of two and grandmother of many, was telling me there was something wrong with my milk and I should quit breastfeeding immediately. She repeatedly shared her story of being ‘informed’ by doctors decades ago that her breast milk was bad, and how much better formula was. She’d put her children on formula in the first week of their lives and was quite adamant that was best. She grew more aggressive about this advice by the day, as my daughter continued to fail to thrive.

As a new and inexperienced mum, it was hard.

As it turns out, my daughter has an intolerance to cows milk and the common commercial milk-based formula she was prescribed was causing her terrible pain and was preventing her from putting on weight. The doctor attributed it to breastfeeding trouble and lack of milk supply on my behalf, but that just didn’t feel right to me. When I finally refused to give her any more supplementary feeds of infant formula, her condition turned around dramatically. She thrived exclusively on my milk, put on weight, began to sleep well, and her colicky stomach problems, constant crying, vomiting and related rash and dry skin disappeared almost overnight.

She has been a happy, healthy baby since, and at nearly 15 months we are still enjoying breastfeeding, but it was a tense and extremely emotionally tough and confusing first 3-4 weeks and if I hadn’t been so supported by the patient and well-educated midwives in hospital, the breastfeeding-friendly community nurse in my area, and if I hadn’t had access to some good evidence-based information, I am sure I would have believed I had failed at breastfeeding, or my milk was ‘bad’ and given up.

Though each mother’s story is different, a lot of the same themes emerge. We want to breastfeed, but find ourselves up against seemingly insurmountable obstacles. I consider myself lucky to be breastfeeding now, but women should not have to be lucky to be able to breastfeed successfully. The fact that the majority of Australian women quit breastfeeding before they want to is simply not good enough.

Let us be clear. Women in countries with higher breastfeeding rates are not better mothers. They are not built differently. They do not have better breasts. They live in more breastfeeding friendly cultures, where breastfeeding is seen as the natural process that it is and the health care system fully supports their needs.

We can all work together to encourage this move toward a more tolerant breastfeeding friendly and baby friendly culture.

When mothers make informed choices, lets respect those choices, regardless of whether than means breastfeeding or bottle feeding, or styles of parenting we don’t agree with. And for the majority of women who do choose to breastfeed, lets give them our unreserved support in the health care system and at work, but also in the community, so they can develop healthy, long-lasting breastfeeding relationships with their children and can be absolutely comfortable breastfeeding anytime, anywhere, when their children need it, for as long as they choose.